Basic facts
- Antimicrobial resistance poses a global threat to health and development and calls for urgent multisectoral action to achieve the Sustainable Development Goals.
- The organization announced that antimicrobial resistance is one of the ten major global public health threats facing humanity.
- Misuse and overuse of antimicrobials are the main drivers of the emergence of drug-resistant pathogens.
- Lack of clean water and sanitation services and inadequate infection prevention and control promote the spread of microbes, some of which can be resistant to antimicrobial treatment.
- Antimicrobial resistance incurs a huge cost to the economy. In addition to causing death and disability, prolonged illnesses result in patients staying in hospital for longer periods of time, needing more expensive medications, and facing financial challenges.
- The success of modern medicine in treating infections, particularly during major surgeries and cancer chemotherapy, is at increased risk unless effective antimicrobials are used.
What are antimicrobials?
Antimicrobials, including antibiotics, antivirals, antifungals, and antiparasitics, are medicines used to prevent and treat infections in humans, animals, and plants.
What is antimicrobial resistance?
Antimicrobial resistance occurs when bacteria, viruses, fungi and parasites change over time and become unresponsive to drugs, making infections more difficult to treat and increasing the risk of widespread disease, severe illness and death.
Antibiotics and other antimicrobial drugs are becoming ineffective due to drug resistance, and infections are becoming increasingly difficult or impossible to treat.
Why is antimicrobial resistance a global concern?
Our ability to treat common infections continues to be threatened by the emergence and spread of drug-resistant pathogens that have acquired new resistance mechanisms resulting in the emergence of antimicrobial resistance. Of particular concern is the rapid global spread of multi- or all-drug-resistant bacteria (also known as “bug bugs”) causing infections that cannot be treated with currently available antimicrobial drugs, such as antibiotics.
There are no new antimicrobials in clinical development. In 2019, WHO identified 32 antibiotics in clinical development that matched the WHO's list of priority pathogens, of which only six were classified as innovative. Moreover, the difficulty of obtaining high-quality antimicrobials remains a major problem. Antibiotic supply shortages affect countries at all levels of development, especially in health care systems.
Antibiotics continue to become increasingly ineffective as drug resistance spreads globally, resulting in more difficult-to-treat infections and deaths. There is an urgent need to find new antibacterials - for example to treat carbapenem-resistant Gram-negative bacterial infections, as identified in the WHO list of priority pathogens. But if people do not change the way they use antibiotics now, the fate of these new antibiotics will be the same as existing antibiotics, and they will lose their effectiveness.
National economies and health systems incur significant costs due to antimicrobial resistance, which affects the productivity of patients or their caregivers by prolonging patients' length of stay in hospitals and requiring them to provide them with more expensive and more intensive care.
The number of people who fail treatment or die from infections will increase unless effective tools are provided to prevent and adequately treat drug-resistant infections, and unless access to existing and new antimicrobials is improved with guaranteed quality. Medical procedures, such as surgical procedures, including caesarean sections or hip replacements, cancer chemotherapy and organ transplants, will also become more risky.
What accelerates the emergence and spread of antimicrobial resistance?
Antimicrobial resistance occurs naturally over time, usually through genetic changes. Antimicrobial-resistant organisms are found in humans, animals, food, plants and the environment (in water, soil and air), and can be transmitted from person to person or from person to animal, including through foods of animal origin. The main drivers of the emergence of this resistance include misuse and overuse of antimicrobials; Lack of access to clean water, sanitation and hygiene services for both humans and animals; Poor infection and disease prevention and control in healthcare facilities and farms; Poor access to high-quality and affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; Lack of enforcement of legislation.
the current situation
Bacterial drug resistance
Common bacterial infections, including urinary tract infections, sepsis, sexually transmitted infections and some forms of diarrhea, are becoming increasingly resistant to antibiotics commonly used to treat these infections worldwide, suggesting that we are running out of effective antibiotics. For example, the resistance rate of Escherichia coli to the commonly used antibiotic ciprofloxacin to treat urinary tract infections ranged between 8.4 and 92.9%, while the resistance rate of Klebsiella pneumoniae to it ranged between 4.1 and 79.4% in countries where Reports to the Global Antimicrobial Resistance and Use Surveillance System.
Klebsiella pneumoniae is a common type of intestinal bacteria capable of causing life-threatening infections, and its resistance to treatment (with carbapenem antibiotics) of last resort has spread throughout all regions of the world. Klebsiella pneumoniae is one of the most important causes of hospital-acquired infections, such as pneumonia, bloodstream infections, and infections affecting newborns and patients staying in intensive care units. In some countries, carbapenem antibiotics are not effective in treating more than half of patients with Klebsiella pneumoniae infections due to antibiotic resistance.
Resistance of Escherichia coli to fluoroquinolone antibiotics used to treat urinary tract infections is widespread.
There are countries in many regions of the world where this treatment has become useless among more than half of patients.
Colistin is the only last resort for the treatment of life-threatening infections caused by carbapenem-resistant enteric bacteria (e.g. E. coli, Klebsiella, etc.). Colistin-resistant bacteria have also been detected in many countries and territories, resulting in infections for which there are currently no effective antibiotics to treat.
Staphylococcus aureus bacteria are part of our skin flora and are a common cause of infections in both communities and healthcare facilities. People with MRSA infections are 64% more likely to die than people with drug-sensitive infections.
In 2019, a new indicator on antimicrobial resistance was included in the monitoring of the Sustainable Development Goals, which monitors the frequency of bloodstream infections caused by the following two drug-resistant pathogens: methicillin-resistant Staphylococcus aureus; E. coli resistant to third-generation cephalosporins. In 2019, data from 25 countries, territories and regions on bloodstream infections caused by methicillin-resistant Staphylococcus aureus were submitted to the Global Antimicrobial Resistance and Use Surveillance System, as were data from 49 countries on bloodstream infections caused by Escherichia coli. Although the data are not yet nationally representative, the average observed rate for methicillin-resistant Staphylococcus aureus was 12.11% (interquartile range 6.4-26.4), and for E. coli resistant to the third generation cephalosporin, 36.0% (interquartile range 15.2-63.0).
The management and control of gonorrhea is being jeopardized by the widespread drug resistance of Neisseria gonorrhoeae and its highly divergent strains. Resistance to sulfonamides, penicillins, tetracyclines, macrolides, fluoroquinolones, and first-generation cephalosporins quickly emerged. Broad-spectrum cephalosporin and ceftriaxone injection currently represents the only remaining empirical treatment for gonorrhea in most countries.
Drug resistance of Mycobacterium tuberculosis
Antibiotic-resistant strains of Mycobacterium tuberculosis threaten progress made in containing the global tuberculosis epidemic. The organization estimates that in 2018, approximately half a million new cases of rifampicin-resistant TB were identified in the world, most of them cases of multidrug-resistant TB, a form of TB that is resistant to the two most powerful anti-TB drugs. In 2018, only a third of nearly half a million people infected with multidrug-resistant/rifampicin-resistant TB were detected and reported. Treating multidrug-resistant tuberculosis requires longer-term, less effective, and more expensive treatment courses than those needed to treat its non-drug-resistant counterpart, noting that the percentage of people treated for multidrug-resistant/rifampicin-resistant tuberculosis who are successfully cured is less than 60%.
In 2018, it was estimated that 3.4% of new TB cases and 18% of previously treated cases were multidrug-resistant/rifampicin-resistant, and that there is a high risk of the emergence of TB resistance to new drugs that represent the last resort for treating drug-resistant TB. .
Virus drug resistance
Antiviral drug resistance is of increasing concern in immunocompromised patient populations in cases where continued viral replication and prolonged drug administration lead to selection of resistant strains. Viruses have developed resistance to most antiretroviral drugs, including antiretrovirals.
All antiretroviral drugs, including newer classes, are at risk of losing their effectiveness partially or completely due to the emergence of HIV drug resistance. People on antiretroviral therapy can become infected with drug-resistant HIV, or they can become infected with HIV that is already drug-resistant. Levels of pretreatment of this drug-resistant virus with nucleoside reverse transcriptase inhibitors among adults initiating first-line treatment exceed 10% in most countries monitored in Africa, Asia and Latin America, and its prevalence rates among infants are alarmingly high. In sub-Saharan Africa, more than 50% of newly diagnosed infants with HIV are resistant to nonnucleoside reverse transcriptase inhibitors. Guided by these findings, recent WHO guidelines on antiviral medicines now recommend a new drug, dolutegravir, as the preferred first-line treatment for adults and children. Perhaps the use of this drug is particularly urgent in order to avoid the negative effects of the virus’s resistance to non-nucleoside reverse transcriptase inhibitors.
High levels of resistance have significant economic implications because second- and third-line courses are much more expensive than first-line drugs. The WHO's program to combat HIV drug resistance monitors the transmission and emergence of resistance in old and new medicines used around the world to treat the virus.
Drug resistance of malaria parasites
The emergence of drug resistance in parasites poses one of the major risks to malaria control and increases morbidity and mortality rates. Artemisinin-based combination therapies are recommended as first-line treatment for uncomplicated cases of Plasmodium falciparum malaria and are used by most malaria-endemic countries. These treatments are a combination of artemisinin components and similar medications. In the WHO Western Pacific and South-East Asia regions, partial resistance to artemisinin and resistance to several drugs similar to artemisinin-based combination therapies were confirmed in Cambodia, Lao People's Democratic Republic, Myanmar, Thailand and Viet Nam, in studies conducted between 2001 and 2019. This makes it difficult to choose the correct treatment and requires close monitoring.
In the WHO Eastern Mediterranean Region, P. falciparum resistance to sulfadoxine-pyrimethamine has resulted in failures in artesunate-sulfadoxine-pyrimethamine combination therapy in some countries, necessitating the use of another artemisinin-based combination therapy option.
Evidence was recently published in Africa proving the emergence of mutations resulting from partial resistance to this substance in Rwanda. To date, proven artemisinin-based combination therapies remain highly effective, but the continued spread of malaria resistance to artemisinin and similar drugs could pose a major public health challenge and jeopardize the significant gains made in malaria control.
Drug resistance of fungi
The prevalence of drug-resistant fungal infections continues to increase, making an already dire treatment situation more difficult. There are currently many problems with the treatment of many fungal infections, such as toxicity to which patients with other underlying infections (eg, HIV) are particularly susceptible. Drug-resistant C. albicans is already widespread, one of the most common invasive fungal infections, and resistance to fluconazole, amphotericin B and voriconazole is increasingly being reported, as well as the emergence of caspofungin resistance.
This leads to increased difficulty in treating fungal infections, failure to treat them, prolonged hospital stays, and significant increases in the costs of treatment options. WHO is conducting a comprehensive review of fungal infections in the world and will publish a list of fungal pathogens important to public health along with an analysis of antifungal medicines in development.
The need to coordinate procedures
Antimicrobial resistance is a complex problem that requires a unified, multi-sectoral approach to solve it. The One Health approach brings together many sectors and stakeholders working in the field of preserving the health of humans, animals, terrestrial and aquatic plants, food and feed production, and the environment in order to communicate and work together in the field of formulating and implementing programs, policies, legislation, and research to achieve better public health outcomes.
There is a need to enhance innovation and increase investments in practical research and R&D activities related to the development of antimicrobial drugs, vaccines and diagnostics, especially those aimed at combating serious Gram-negative bacterial infections, such as enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii. The launch of the Multi-Partner Trust Fund for Antimicrobial Resistance, the Global Partnership for Antibiotic Research and Development, the Action Fund to Combat Antimicrobial Resistance and other funds and initiatives could fill a significant funding gap. Multiple governments continue to experiment with payment models in this area, including Sweden, Germany, the United States and the United Kingdom, and more initiatives are needed to find durable solutions.
Global action plan on antimicrobial resistance
Countries globally committed to the framework set out in the 2015 Global Action Plan on Antimicrobial Resistance1 during the World Health Assembly in 2015, and to develop and implement national multisectoral action plans. The plan was later approved by the governing bodies of the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health. To ensure sustainable global progress, countries need to ensure that national action plans are costed and implemented across all sectors. Before the adoption of the Global Action Plan in 2015, global efforts to contain antimicrobial resistance included the WHO Global Strategy for Containing Antimicrobial Resistance developed in 2001, which sets out a framework for interventions to be implemented to slow the emergence of antimicrobial resistance and limit its spread.
Tripartite Joint Secretariat on Antimicrobial Resistance
The political declaration issued at the United Nations High-level Meeting on Antimicrobial Resistance, which was committed by heads of state at the United Nations General Assembly in New York in September 2016, emphasized its strong focus on a broad and coordinated approach that engages all sectors, including sectors of human health Animals, plants and the environment. FAO works closely with the Food and Agriculture Organization and the World Organization for Animal Health under the “One Health” approach to promote best practices to reduce levels of antimicrobial resistance and slow its development.
The Secretary-General of the United Nations convened a meeting of the Inter-Agency Coordination Group on Antimicrobial Resistance (the Coordination Group) following the United Nations High-level Meeting on Antimicrobial Resistance in 2016. This Coordination Group brought together partners from across the United Nations and organizations International and individuals with expertise in human, animal and plant health, as well as the food and animal feed, trade, development and environment sectors, to formulate a plan to combat antimicrobial resistance. The Coordination Group submitted its report, “ No Time to Wait: Securing the Future from Drug-Resistant Infections, ” to the Secretary-General of the United Nations in April 2019, and its recommendations are currently being implemented.
A joint tripartite secretariat (FAO, OIE and FAO) hosted by FAO was established to encourage multi-stakeholder engagement in the fight against antimicrobial resistance. The main governance structures agreed include the One Health Global Leadership Group on Antimicrobial Resistance, which began its work in November 2020, the Independent Expert Group on Evidence for Antimicrobial Resistance Efforts and the Multilateral Partnership Platform to Combat Antimicrobial Resistance, which Work is currently underway to establish them.
World Antimicrobial Awareness Week
World Antimicrobial Awareness Week was previously called World Antibiotic Awareness Week. Since 2020, it has been called World Antimicrobial Awareness Week, embodying the expanded scope of this week that includes all antimicrobials, including antibiotics, antifungals, antiparasitics and antivirals. This week, which has been held annually since 2015, is a global campaign aimed at raising awareness of antimicrobial resistance around the world and encouraging the general public, health workers and policy makers to follow best practices to slow the development and spread of drug-resistant infections. The Tripartite Executive Committee decided to set a date for this week’s celebration, from 18 to 24 November. The general slogan of the week for the past five years has been “Antibiotics: Handle with care,” which was changed in 2020 to “Handle antimicrobials with care.”
Global surveillance system for antimicrobial resistance and use
In 2015, WHO launched the Global System for Surveillance of Antimicrobial Resistance and Use (Global System) with the aim of continuing to fill knowledge gaps and inform strategies at all levels. The global system is designed to progressively integrate data from human antimicrobial resistance surveillance, antimicrobial drug use surveillance and antimicrobial resistance in the food chain and in the environment. The global system provides countries, territories and regions with a unified approach to collecting, analysing, interpreting and sharing data, and monitors the status of existing and new national surveillance systems, focusing on the representativeness and quality of data collection. Some FAO Regions have established surveillance networks that provide countries with technical support and facilitate their inclusion in the global system.
Prioritization of global research and development activities in the field of antimicrobial resistance
In 2017, WHO prepared a list of priority pathogens to guide research and development activities for the development of antimicrobials, diagnostics and vaccines, and this list will be updated in 2022. The organization annually reviews the status of antimicrobial development in the preclinical and clinical phase in order to review the progress of their development. Based on WHO's list of priority pathogens. There remains a serious gap in research and development activities, especially for antimicrobials targeting carbapenem-resistant Gram-negative bacteria.
Global Antibiotic Research and Development Partnership
The Global Partnership for Antibiotic Research and Development (Global Partnership) is a global, non-profit partnership that aims to develop treatments for drug-resistant infections that pose the greatest threat to health. The global partnership works across sectors to ensure equitable access to treatments and promote their responsible use.